Reclaiming the Run: The Athlete's Guide to Overcoming Injury and Returning to Peak Performance

It happened. You've experienced an injury, and now the sport that used to bring you joy has become frustrating and bothersome. Pain has entered the equation, and you're faced with the possibility of taking time off and losing fitness or even losing the activity that used to be the highlight of your busy workday. Luckily, you're working with a skilled physical therapist who is guiding you through the rehabilitation process. Let's discuss the key points that every athlete should consider on their journey back to full sport participation after an injury.

I'll use running as the primary example, but these principles of reintegration apply to all activities. At Steady State, we follow this philosophy for our diverse range of patients, including barbell athletes, rock climbers, and mountain bikers, not just runners.

Finding the Entry Point

The first step is to determine the level of activity that your body can tolerate. While complete rest is rarely necessary, it is often the first drastic measure taken. Many people believe that if running causes pain, they should stop running to allow the injured area to heal. However, extended rest leads to decreased fitness and reduces the injured area's tolerance for the sport, which can hinder recovery.

The goal is to identify the maximum amount of activity that your body can handle with minimal provocation. This is your entry point. Discuss with your physical therapist ways to reduce running volume, frequency, intensity, or workouts while still maintaining a tolerable level of running. If necessary, explore alternative activities such as biking or using an ergometer to stress the tissues and provide a training stimulus. It's important to define what "tolerable" means in relation to your injury, as there may be some gray area when it comes to acceptable pain levels and what is beneficial for therapeutic progress, depending on the tissues involved.

Modifiable Factors

Modifiable factors are temporary adjustments that offload stress from the injured area, facilitating both rehabilitation and training. Examples of modifiable factors include taping, manual therapy, footwear, heel cups, training surface, and orthotics. It's crucial for the treating practitioner to establish that these factors aid in additional strengthening or running tolerance and are not a long-term fix. Too often, these factors are presented as a quick "cure" in the world of rehabilitation, which is not the case. Modifiable factors work hand in hand with finding a better entry point for the athlete, preventing them from being stuck in a cycle of rest followed by reinjury.

Graded Exposure

Now that the entry point has been determined and an evidence-based rehabilitation program has been implemented, it's time to gradually increase the training load. The typical adjustment is to increase running volume by adding more miles or time per week. The goal is to expose the now stronger and less reactive tissues to increasing doses of normal activity specific to your sport.

Running itself becomes a form of treatment. For example, if your goal is to return to trail running, you gradually adjust the percentage of road running to trail running, moving closer to off-road conditions. The key is to avoid making too many changes at once and instead take incremental steps toward normal activity. The FITT model, explained in more detail in a previous blog post (link provided), is a great way to manage these areas.

Understanding Progression

At this point, your running is going well, progress is being made, and you can see the finish line that represents your normal activity level. But suddenly, the pain returns, and your outlook becomes bleak as it seems like your rehab has regressed back to square one.

Encountering setbacks is common, so much so that they're almost guaranteed during physical therapy. It can be challenging to recognize progress when most people view it as a straight line to success.

Rehabilitation progress can be measured in multiple ways. The most obvious is a decrease in pain as you increase your running volume. However, there are two additional scenarios that indicate optimal progress. The first is a decrease in pain while maintaining the same level of activity. The second, and often forgotten, scenario is experiencing the same level of pain while increasing your activity. All three of these scenarios represent significant strides in rehabilitation and should be celebrated.

A setback is merely a slight overreach of stress on the injured tissue, indicating a need for a minor adjustment to the current rehab program to get back on track. By not becoming too frustrated with setbacks and taking the time to understand why they occurred, you set yourself up for a full recovery.

Congratulations! You've persevered and are now running at full capacity. If you haven't reached this point yet, having a running-focused physical therapist as your guide can be tremendously helpful.

Remember, the journey back to full sport participation after an injury requires finding the entry point, considering modifiable factors, implementing graded exposure, and understanding the ups and downs of progress. By following these principles and working closely with a knowledgeable physical therapist, you'll be on your way to reclaiming the activities you love and achieving your athletic goals.